Individual
MS. KELLY MICHELLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4230 TREE MOSS PL, HUMBLE, TX 77346-4560
(281) 454-4497
Mailing address
2407 PERRY ST, BAYTOWN, TX 77521-1074
(281) 896-1198
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
CPT14091
CA
246Z00000X
Other Specialist/Technologist
CERTIFIED BIOTECH
CA
Other
Enumeration date
09/24/2010
Last updated
09/24/2010
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